Abstract
Abstract
Purpose
There isscarce evidence to date on how temperature develops during holmium laser enucleation of the prostate (HoLEP). We aimed to determine the potential heat generation during HoLEP under ex vivo conditions.
Methods
We developed two experimental setups. Firstly, we simulated HoLEP ex vivo using narrow-neck laboratory bottles mimicking enucleation cavities and a prostate resection trainer. Seven temperature probes were placed at different locations in the experimental setup, and the heat generation was measured separately during laser application. Secondly, we simulated high-frequency current-based coagulation of the vessels using a roller probe.
Results
We observed that the larger the enucleated cavity, the higher the temperature rises, regardless of the irrigation flow rate. The highest temperature difference with an irrigation flow was approximately + 4.5 K for a cavity measuring 100ccm and a 300 ml/min irrigation flow rate. The higher flow rate generates faster removal of the generated heat, thus cooling down the artificial cavity. Furthermore, the temperature differences at different irrigation flow rates (except at 0 ml/min) were consistently below 5 K. Within the resection trainer, the temperature increase with and without irrigation flow was approximately 0.5 K and 3.0 K, respectively. The mean depth of necrosis (1084 ± 176 µm) achieved by the roller probe was significantly greater when using 144 W energy.
Conclusion
Carefully adjusted irrigation and monitoring during HoLEP are crucial when evacuating the thermal energy generated during the procedure. We believe this study of ours provides evidence with the potential to facilitate clinical studies on patient safety.
Funder
Albert-Ludwigs-Universität Freiburg im Breisgau
Publisher
Springer Science and Business Media LLC
Reference19 articles.
1. Fraundorfer MR, Gilling PJ (1998) Holmium:YAG laser enucleation of the prostate combined with mechanical morcellation: preliminary results. Eur Urol 33:69–72. https://doi.org/10.1159/000019535
2. Nair SM, Pimentel MA, Gilling PJ (2016) A review of laser treatment for symptomatic BPH (Benign Prostatic Hyperplasia). Curr Urol Rep 17:45. https://doi.org/10.1007/s11934-016-0603-5
3. Vincent MW, Gilling PJ (2015) HoLEP has come of age. World J Urol 33:487–493. https://doi.org/10.1007/s00345-014-1443-x
4. Patel A, Nunez R, Mmeje CO, Humphreys MR (2014) Safety and feasibility of concomitant surgery during holmium laser enucleation of the prostate (HoLEP). World J Urol 32:1543–1549. https://doi.org/10.1007/s00345-014-1254-0
5. Sivarajan G, Borofsky MS, Shah O, Lingeman JE, Lepor H (2015) The role of minimally invasive surgical techniques in the management of large-gland benign prostatic hypertrophy. Rev Urol 17:140–149